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General NPI Number Information
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NPI Number | 1194728147
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Entity Type | Organization
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Legal Business Name | BADER PROSTHETICS & ORTHOTICS, INC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 125 CHAPMAN RD E
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City | LUTZ
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State | FL
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Zip | 33549-8106
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Country | US
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Telephone | 813-962-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 125 CHAPMAN RD E
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City | LUTZ
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State | FL
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Zip | 33549-8106
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Country | US
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Telephone | 813-962-6100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WADE BADER
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Credential | CPO
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Telephone | 813-962-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | POR53
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License Number State | FL
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